Frequently asked questions about hospital standardized mortality ratio (mortality rates)

No. The HSMR results should not be used as a guide of choosing where to seek care. A higher than average HSMR result does not necessarily mean that a hospital is “unsafe” – nor does a lower than average HSMR mean a hospital is “safe.” Patients should know that KGH is safe and that the care they receive is top-notch. Every effort – on behalf of everyone serving patients in a hospital – is made to ensure patients receive the highest-quality care possible. Hospital care is complicated and depends on many factors, not all of which are reflected or accounted for by HSMR. That is why many indicators must be examined in order to get a sense of how hospitals are performing – where they excel and where improvements could be made. It is important to look at all of these indicators in combination. To judge performance on only one indicator would be misleading.

The HSMR is an overall quality indicator and measurement tool that allows for comparison of an acute care hospital’s mortality rate with the overall mortality rate among peer hospitals and regions in Canada. HSMR has been used by many hospitals in several countries to assess and analyze in hospital mortality rates and to help improve quality of care and enhance patient safety. Ontario hospitals are beginning to use the HSMR for internal benchmarking purposes: to show hospitals how their HSMR has changed, where they have made progress and where they can continue to improve.

Morbidity and mortality patterns are changing. Hospitals, like ours, have implemented a range of initiatives to reduce mortality and improve patient care. As a result, HSMR results across the country have been progressively improving. So, this year, CIHI updated the methodology used to calculate HSMR results. For example, Quebec is now included, more diagnoses are added and a new approach to logistic regression modeling is used.

The rate reported by CIHI for KGH has included patients whose secondary diagnosis included palliative care. These are patients whose hospitalization was for the purpose of palliative care for the majority of their hospital stay. Because palliative care was not the primary diagnosis, CIHI has included these patients in their calculation for KGH’s HSMR. At KGH, palliative patients accounted for 64 per cent of deaths last year. Without these palliative care deaths, the HSMR would be lower. 

The Hospital Standardized Mortality Ratio (HSMR) is an overall quality indicator and measurement tool used by all acute care hospitals and regions in Canada. HSMR has been used by many hospitals in several countries to help improve quality of care and enhance patient safety.